Assistive products and childhood neurodisability: a retrospective study on factors associated with aids/orthoses prescription

Assenza, Carla; Cacciatore, Denise; Manica, Mattia; Iosa, Marco; Foti, Calogero; Gobbetti, T.; Paolucci, Stefano; Morelli, Daniela

doi:10.23736/s1973-9087.20.06224-3

Cited by 1 publication

(5 citation statements)

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“…As the Gross Motor Function Classification System (GMFCS) level and disability increase, so does the need for devices and orthoses. 4,8 Depending on insurance status, cost may increase with number of braces prescribed and contribute to lack of brace acquisition or increase in time between prescription and brace pick up when more than 1 brace is prescribed. However, this increase in time for brace acquisition may not be based only on patient demographics but also may be caused by the fact that the prosthetic and orthotic company had to make more than 1 custom brace.…”

Section: Discussionmentioning

confidence: 99%

“…This may be because of the increased burden primary caregivers have in caring for children and adolescents with complex pathologies. As the Gross Motor Function Classification System (GMFCS) level and disability increase, so does the need for devices and orthoses 4,8. Depending on insurance status, cost may increase with number of braces prescribed and contribute to lack of brace acquisition or increase in time between prescription and brace pick up when more than 1 brace is prescribed.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5][6][7][8] They serve to improve gait, increase patient functionality, increase patient autonomy, prevent surgical intervention, and augment postsurgical care. 2,[4][5][6][7][8][9] A considerable amount of research and literature has been devoted to lower extremity brace wear in clubfoot, as well as gait in cerebral palsy. 7,8 Noncompliance with brace wear has been established as a cause of clubfoot recurrence.…”

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confidence: 99%

“…L ower extremity braces are utilized in the treatment of multiple pediatric orthopaedic conditions. [1][2][3][4][5][6][7][8] They serve to improve gait, increase patient functionality, increase patient autonomy, prevent surgical intervention, and augment postsurgical care. 2,[4][5][6][7][8][9] A considerable amount of research and literature has been devoted to lower extremity brace wear in clubfoot, as well as gait in cerebral palsy.…”

mentioning

confidence: 99%

“…Lower extremity braces are utilized in the treatment of multiple pediatric orthopaedic conditions 1–8. They serve to improve gait, increase patient functionality, increase patient autonomy, prevent surgical intervention, and augment postsurgical care 2,4–9.…”

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confidence: 99%

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Factors that Influence Acquisition of Lower Extremity Braces in the Pediatric Orthopaedic Population

Rambo

Rhodes

Lomax

et al. 2021

Journal of Pediatric Orthopaedics

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Background: Lower extremity brace-wear compliance has been studied in pediatrics, but failure to acquire a prescribed brace has not been included. The purpose of this study was to evaluate brace acquisition as a component of brace-wear compliance. Methods: Records of patients (0 to 21 y) prescribed lower extremity braces from 2017 to 2019 were reviewed. Diagnoses included cerebral palsy, spina bifida, short Achilles tendon, clubfoot, and other. Brace type was categorized as clubfoot foot abduction orthosis, ankle-foot orthosis, knee, hip, or custom/ other braces. Brace prescription and acquisition dates were recorded. Insurance was classified as government, private, or uninsured. Patient demographics included age, sex, race, and calculated area deprivation index. Results: Of the 1176 prescribed lower extremity braces, 1094 (93%) were acquired while 82 (7%) were not. The odds ratios (OR) of failure to acquire a prescribed brace in Black and Hispanic patients were 1.64 and 2.71 times that in White patients, respectively (95% confidence interval: 1.01-2.71, P = 0.045; 1.23-5.6, P = 0.015); in patients without insurance, the OR was 8.48 times that in privately insured patients (95% confidence interval: 1.93-31.1, P = 0.007). The ORs of failure to acquire were 2.12 (P = 0.003) in patients 4 years or more versus 0 to 3 years, 4.17 (P < 0.0001) in cerebral palsy versus clubfoot, and 4.12 (P = 0.01) in short Achilles tendon versus clubfoot. There was no significant association between sex or area deprivation index and failure of brace acquisition. Conclusions: In our cohort, 7% of prescribed braces were not acquired. Black or Hispanic race, lack of insurance, and older age were associated with failure to acquire prescribed braces. Braces prescribed for clubfoot were acquired more often than for cerebral palsy or short Achilles tendon. Brace-wear compliance is an established factor in treatment success and recurrence. This study identified risk factors for failed brace acquisition, a critical step for improving compliance. These results may help effect changes in the current system that may lead to more compliance with brace wear. Level of Evidence: Level III-retrospective cohort study.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%